PMID- 28747317
OWN - NLM
STAT- MEDLINE
DCOM- 20180910
LR  - 20181202
IS  - 1708-8267 (Electronic)
IS  - 1081-5589 (Linking)
VI  - 65
IP  - 8
DP  - 2017 Dec
TI  - The risk of postoperative hemorrhage and efficacy of heparin for preventing deep 
      vein thrombosis and pulmonary embolism in adult patients undergoing neurosurgery: 
      a systematic review and meta-analysis.
PG  - 1136-1146
LID - 10.1136/jim-2016-000235 [doi]
AB  - The aim of this meta-analysis was to examine the risk of postoperative bleeding 
      and efficacy of heparin for preventing deep vein thrombosis (DVT) and pulmonary 
      embolism (PE) in adult patients undergoing neurosurgery. MEDLINE, Cochrane, and 
      EMBASE databases were searched until October 31, 2016, for randomized controlled 
      trials (RCTs) and non-randomized comparative studies that assessed the rates of 
      postoperative hemorrhage, DVT, PE, and mortality in adult patients undergoing 
      neurosurgery. Nine eligible studies (five RCTs, four retrospective studies) 
      including 874 patients treated with either unfractionated heparin (UFH) or 
      low-molecular-weight heparin (LMWH) and 1033 patients in control group (placebo 
      with or without compression device) were analyzed. The overall analysis revealed 
      that there was an increase in the risk of postoperative hemorrhage in patients 
      who received heparin (pooled OR 1.66, 95% CI 1.01 to 2.72, p=0.046) compared with 
      no treatment group. The risk of postoperative hemorrhage was more significant if 
      only RCTs were included in analysis. Heparin prophylaxis was associated with a 
      decrease in the risk of DVT (pooled OR 0.48, 95% CI 0.36 to 0.65, p<0.001) and PE 
      (pooled OR 0.25, 95% CI 0.09 to 0.73, p=0.011) but it did not affect the rate of 
      mortality. In conclusion, heparin increased the rate of postoperative bleeding, 
      decreased the risk of DVT, PE and venous thromboembolic event (VTE) but it did 
      not affect the mortality of patients undergoing neurosurgery. For the heparin 
      prophylaxis, the trade-off between the risk of postoperative bleeding and benefit 
      of prophylaxis against VTEs requires further investigation.
CI  - (c) American Federation for Medical Research (unless otherwise stated in the text 
      of the article) 2017. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Wang, Xuan
AU  - Wang X
AD  - Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Zhou, Ying-Chun
AU  - Zhou YC
AD  - Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Zhu, Wen-De
AU  - Zhu WD
AD  - Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Sun, Yun
AU  - Sun Y
AD  - Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Fu, Peng
AU  - Fu P
AD  - Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Lei, De-Qiang
AU  - Lei DQ
AD  - Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Zhao, Hong-Yang
AU  - Zhao HY
AD  - Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170726
PL  - England
TA  - J Investig Med
JT  - Journal of investigative medicine : the official publication of the American 
      Federation for Clinical Research
JID - 9501229
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Middle Aged
MH  - *Neurosurgery
MH  - Postoperative Hemorrhage/*etiology/mortality
MH  - Publication Bias
MH  - Pulmonary Embolism/*drug therapy/mortality/*prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
MH  - Venous Thrombosis/*drug therapy/mortality/*prevention & control
OTO - NOTNLM
OT  - anticoagulation
OT  - deep vein thrombosis
OT  - heparin
OT  - intracranial surgery
OT  - postoperative bleeding
OT  - pulmonary embolism
COIS- Competing interests: None declared.
EDAT- 2017/07/28 06:00
MHDA- 2018/09/11 06:00
CRDT- 2017/07/28 06:00
PHST- 2017/06/24 00:00 [accepted]
PHST- 2017/07/28 06:00 [pubmed]
PHST- 2018/09/11 06:00 [medline]
PHST- 2017/07/28 06:00 [entrez]
AID - jim-2016-000235 [pii]
AID - 10.1136/jim-2016-000235 [doi]
PST - ppublish
SO  - J Investig Med. 2017 Dec;65(8):1136-1146. doi: 10.1136/jim-2016-000235. Epub 2017 
      Jul 26.